Tag Archives: Illinois

The unsustainable cost of Obamacare in Illinois.

The state of Illinois would like to thank the other 49 states for their massive, forcibly redistributed financial contribution towards the anticipated cost to cover Illinois’ projected Obamacare implementation and first year operating costs (January 1, 2012-December 31, 2014) of $135 million. Thus far…

$115 million has been received for the Illinois Obamacare exchange “Marketing, Outreach and Information Technology”, of which:

$28 million went to 44 “community groups” in Illinois that will be conducting “outreach” providing “education” and facilitating enrollment in the Illinois Obamacare Exchange through the IPA – In Person Assister – program.

$35 million went to PR firm Fleishman Hillard to market and promote the Illinois Obamacare Exchange. The firm, along with several partners, will lead a massive multimedia outreach and advertising campaign to promote enrollment in the Illinois Obamacare Exchange.

$66.5 million went to a CANADIAN firm known as CGI Technologies and Solutions who will be responsible for setting up and maintaining the Illinois Obamacare Exchange which will also interface with Illinois’ eligibility system for Medicaid. Because you know, we’re adding an estimated 700,000 people onto our already bankrupt Illinois Medicaid program.

This Medicaid expansion will cost the taxpayers of Illinois:

$179,758,409 (that we do not have) in 2017
$227,311,277 (that we do not have) in 2018
$278,731,610 (that we do not have) in 2019
$417,523,899 (that we do not have) in 2020

Whether you use the Kaiser Family Foundation estimates, the Cato Institute estimates or the Congressional Budget Office. The expansion of Medicaid under Obamacare will put a significant new burden on the taxpayer. This is because Obamacare promises 100% matching federal Medicaid dollars for years 2014 through 2016 and 90% for years 2020 onward for states that elect to expand their Medicaid rolls. Even President Obama’s Medicare Actuary Charles Blahous doubts that promise. Most especially since the President’s own submitted budgets, as well as the bipartisan Simpson–Bowles Commission, and the budget resolution passed by the House of Representatives in 2012 already call for trimming Medicaid spending by a minimum of $100 billion.

Old Medicaid ‘eligibles’ and new Medicaid ‘eligibles’

Whilst the Obama administration touts the fact that Obamacare calls for the aforementioned matching federal funding for those who will be newly eligible for Medicaid in 2014. It is far less vocal about the fact that it only provides the existing or Traditional FMAP percentage match rate for the millions of Americans who were always eligible for Medicaid but either never knew they were or never bothered to enroll. These ‘old eligibles’ will now be required by federal law to maintain ‘minimum essential coverage‘ via Medicaid. Which means the vast majority of them will be enrolling in 2014 in order to avoid problems with the IRS. How much will the Traditional FMAP federal percentage match be in 2014? In states like Illinois and others it will be only 50%.

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Who picks up the other half? That’s right, the state tax payer. Keep in mind Illinois taxpayers that this new tax increase will be in addition to the 66.66% tax increase Governor Quinn already imposed upon you in January 2011 and the $350 million additional tax increase in May 2012. How much will picking up the other half of the cost to enroll ‘old eligibles’ (‘woodwork’ population) and the cost of enrolling ‘new eligibles’ cost Illinois taxpayers? See chart below. Look at CATO’s estimate of $10.1 billion.

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The Obamacare ‘fix’ to Medicaid reimbursement rates to doctors.

Another state budget buster will be the Obamacare ‘fix’ to Medicaid reimbursement levels to doctors. You see the PPACA’s answer to improving Medicaid is to raise the amount the federal government pays to doctors who take MedicAID patients to a level commensurate to what the federal government pays to doctors who take MediCARE patients. Their thought process behind doing so is that more doctors will accept Medicaid under this arrangement because the reimbursement rate will be far higher. There’s only one problem. The federal government only provides funding for this massive increase in Medicaid reimbursement ratios for the first 2 years. Afterward, state tax payers are on the hook for the rest.

This, more than anything else related to Medicaid expansion is a fiscal ticking time bomb for state budgets and one that is not being discussed nearly enough. Furthermore, just wait until hospitals – who are forced to treat emergency patients under EMTALA – start pressuring states for reimbursement of more than $11 billion in annual federal payment cuts for uncompensated care. Hospitals are a powerful lobbying force and they will lobby hard for that money.

The Illinois Policy Institute predicts that 1 in 3 Illinois residents will be Medicaid recipients by 2019. And, on January 30, 2012, the Civic Federation released its “Budget Roadmap” for the coming fiscal year. In it, they highlight the fact that state officials now believe that the Illinois Medicaid program will have between $21 and $23 billion in UNPAID bills by 2017. ‘Forward’…. to bankruptcy.

Medicaid is a dangerous government welfare program

The worst part about this expensive expansion of Medicaid is that according to multiple studies completed by Johns Hopkins, the Journal of the National Cancer Institute, Columbia-Cornell, the University of Pennsylvania, the University of Pittsburgh, the American Academy of Cardiology and the New England Journal of Medicine, Medicaid patients in bankrupt states like Illinois & California wait twice as long to see a doctor or specialist as those with private health insurance. And, often times they are denied the care they need.

And, Medicaid surgical patients have far worse health outcomes than those with private insurance. In fact, in the largest study of it’s kind (with nearly 1,000,000 participants) the University of Virginia found that Medicaid surgical patients are 97% more like to DIE than surgical patients with private health insurance.

A better way “forward”

There are intelligent alternatives to simply flooding our bankrupt Medicaid rolls with 17 million more Americans. In fact, these alternatives have already been proven successful in states like Florida, Indiana and Louisiana. Sadly, our Democrat Governor Pat Quinn and even Republican governors like Arizona’s Jan Brewer and Ohio’s John Kasich haven’t learned a thing from these successful reforms. Instead, they have chosen to double down on failure by expanding Medicaid to historic proportions. Worse yet, they want you to pay for their wrong headed decisions via higher taxes and more ‘cost shifting‘. Both of which will do nothing but continue to increase the cost of health insurance for everyone else.

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Shocking Medicare and Medicaid fraud exposed at Illinois’ Sacred Heart Hospital

Sacred Heart hospital on Chicago’s west side is now a focal point for federal investigators following alleged Medicare and Medicaid fraud charges. Thus far 6 people have been arrested, including Sacred Heart’s owner and CEO – Edward J. Novak, of Park Ridge, and Sacred Heart’s executive V.P. and CFO – Roy M. Payawal, 64, of Burr Ridge. According to a press release from the U.S. Attorney’s office some of the alleged fraud details are shocking:

“Between January 2010 and February 2013, May allegedly received $74,000 in the form of 37 checks, for $2,000 each, disguised as ‘rental payments’; Moshiri, a podiatrist, allegedly received $86,000 in 38 checks pursuant to a purported contract to teach podiatry students; and Maitra allegedly received $68,000 in 34 checks pursuant to a purported teaching contract – and the $228,000 total in alleged kickbacks were all in exchange for their referral of patients to Sacred Heart, the charges allege.
 
“In a recorded conversation last month, Maitra allegedly explained to Administrator A that he used to make Novak ‘so much money’ performing almost daily penile implant procedures on patients, but that he no longer performed as many of those procedures because Medicare had decreased its rates of reimbursement for the procedure. Maitra did not comment on whether the patient need for the procedure had somehow changed, according to the affidavit.”
 
“On March 1, 2013, Administrator A recorded Novak stating that tracheotomies are Sacred Heart’s ‘biggest money maker’ and the hospital can make $160,000 for a tracheotomy if the patient stays 27 days. On March 7, 2013, the Intensive Care Unit case manager told Administrator A that she must often ‘stretch’ a tracheotomy patient’s stay to 28 days to maximize Medicare reimbursements ‘to make Novak happy.’”

Sadly, cases like these are not uncommon in Illinois. In fiscal year 2011, the Department of Health and Human Services reported that in Illinois alone there were:

326 Medicaid fraud investigations
48 were indicted on Medicaid fraud charges
30 were convicted
18 cases of civil settlements/judgments
$47.8 million dollars was recovered in Medicare fraud cases

Until recent legislation was passed in July of 2012, the state of Illinois Medicaid program did not even have a TPA – Third Party Administrator – or other fraud prevention system in place under Rod Blagojevich’s destructive tenure as governor. There was apparently no need for one in Blago’s mind because he was lawless himself. Blago illegally expanded our Illinois Medicaid program to 77,000 illegal aliens – who are still enrolled on our Medicaid program today – and increased the eligibility for one to receive Medicaid to 138% above the Federal poverty level. He did so without our Illinois House or Senate approval.

There is a better way to run Illinois’ Medicaid program. There are proven solutions. They are not new ideas. In fact, if Illinois had emulated Florida’s Medicaid reform program last year, we would have saved $1.1 billion. Or, we could have implemented what former governor Mitch Daniels did to reform Indiana’s Medicaid program. We don’t even need to look to other states for solutions. Our own Jonathan Ingram of the Illinois Policy Institute has penned a recent report that paves the way perfectly for Illinois lawmakers to follow. Will they follow these recommendations? Will Illinois legislators act to protect Illinois’ indigent residents? Or, will they simply auto enroll up to 900,000 more indigent residents – per the President’s health care law – onto a broken, bankrupt, dangerous Medicaid program that is already rationing care? Only time will tell.

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Illinois begins audits and cuts to Medicaid. Rationing of care begins.

On July 7, 2012 the Illinois Tea Party broke down the ‘good’ and ‘bad’ parts of SB2840 and it’s amendments as well as HB5007. Together, these two pieces of legislation comprise what Governor Quinn refers to as ‘Medicaid Reform’. Whilst there was and still is genuine concern over the fiscal impact of Illinois expanding Medicaid nearly 2 years before the rest of the country. There was some good in HB5007. Specifically, the implementation of what most other state Medicaid programs already had in place for years. Namely, a TPA – Third Party Administrator.

The role of this TPA is to audit Illinois’ Medicaid program by verifying each year if current Illinois Medicaid recipients are still:

1.) Living in Illinois.
2.) Still living (not dead)
3.) Making the same income they were when they first qualified. If their income levels have increased rendering them no longer eligible, they are to be purged from our Medicaid rolls.

This is a very good thing since a pharmacist from another state recently stated during testimony that “some of our best customers are on the Illinois Medicaid program.”

The results of the first audit of Illinois’ Medicaid rolls are shocking indeed. According to the Chicago Tribune: Of the first 20,500 recipients screened by an outside contractor, the auditors recommend that 13,709 be removed from the rolls. Yes, that’s two-thirds of the first group screened, flagged as ineligible to receive their current Medicaid benefits. How so? In some cases, the recipients make too much money to qualify. In other cases, they don’t live in Illinois.”

Later in the same article the Tribune states: “Full stop. You may ask, as we do: Why didn’t state officials pluck this low-hanging fruit long ago?If Illinois officials knew, or suspected, that thousands of people were improperly receiving Medicaid coverage, why didn’t they act years ago to save hundreds of millions of taxpayer dollars?”

Since Julie Hamos – Illinois Department of Healthcare and Family Services chief – is quoted in the article as ‘doesn’t yet know‘. The Illinois Tea Party would like to clear up this mystery for her.

During Democrat Governor Rod Blagojevich’s Governorship, our Illinois Medicaid program was expanded illegally without legislative approval. Adding to the rapid bankruptcy of our Illinois Medicaid program was the fact that under Blago’s Governorship, legal residency status was not required on the Illinois’ “All Kids Covered” Medicaid application. Understand that when we use the term legal residency we are referring to U.S. citizenship. It took an investigation conducted by former Chicago Tribune reporter Dennis Byrne to determine just how many illegal immigrants were enrolled on our “All Kids Covered” program. The shocking answer was 75%.

Whilst the Illinois legislature is to be commended for finally implementing a TPA. They are still ignoring one of the largest drains on our Illinois Medicaid program. One that is a clear violation of Federal law. Namely, the 77,000 illegal immigrants who are still enrolled on our Medicaid program. None of which will be removed under Quinn’s ‘Medicaid Reform’ bill or any other legislation proposed.

According to Kaiser Health News the cost to cover just emergency treatment – much of it related to delivering babies – for more than 100,000 illegal immigrants is a $2 billion drain on the federal Medicaid program annually.  This being the case, one must ask. Why is there not a number 4 question added to the above TPA discovery process which asks: Are you a U.S. citizen?

By allowing thousands of illegal immigrants to stay on Illinois Medicaid program, lawmakers are disenfranchising Illinois residents who are not only legal U.S. citizens but are also medically fragile children. Part of Governor Quinn’s aforementioned ‘Medicaid Reform’ bill was $1.6 billion of top down, authoritative, across the board Medicaid cuts. $15 million of which pertain to medically fragile and technology-dependent children.

Equally disruptive and cold-hearted is the fact that Senate Bill 2840 eliminated Illinois’ Cares Rx program, which provides prescription drug coverage for 180,000 fixed and low income Illinois seniors. Seniors on fixed incomes of less than $16,000 have now lost their drug coverage. Community care and in-home care programs also faced severe cuts, resulting in the loss of services for thousands of seniors across the state. There is a word that properly defines this type of top down, authoritative, across the board cuts – rationing. And it’s about to get much, much worse.

Since 2000, Illinois Medicaid rolls have doubled, from fewer than 1.4 million people to nearly 2.8 million, or more than 1 in 5 Illinoisans. Starting in 2014, the President’s health care law is about to exacerbate this problem exponentially. According to various estimates, from 500,000 to more than 900,000 more Illinois residents will qualify for Medicaid when the PPACA (Obamacare) Medicaid expansion takes effect in 2014. This is because the PPACA expands Medicaid to childless adults for the first time ever. There are more than 15.1 million childless adults in the U.S. who will now be eligible for Medicaid. The PPACA also mandates that another 9 million Americans who already qualify for Medicaid but never enrolled do so beginning in 2014.

The ‘silver lining’ in Chief Justice John Roberts historic ruling on the PPACA last year was that states were now given the option to expand Medicaid. Since then many states have run the numbers and decided against expanding Medicaid. In contrast, Governor Quinn is moving ‘forward’ with Medicaid expansion with Senate Bill 26 which will voluntarily expand Illinois’ Medicaid program to nearly 350,000 additional individuals, who are between the ages of 19 and 64 with incomes under 138% of the Federal Poverty Level. The Dept. of Healthcare and Family Services (HFS) states the cumulative cost of this expansion could exceed $2.9 billion by 2020. The Kaiser Commission on Medicaid and the Uninsured estimates a similar number of $2.4 billion by 2020.

Worse yet, our Illinois Medicaid program already has unpaid bills piling up after lawmakers enacted a budget pushing $2.4 Billion of 2011’s bills into 2012. As they have been doing repeatedly for years now. In fact, on January 30, 2012, the Civic Federation released its “Budget Roadmap” for fiscal year 2012. In it, they highlight the fact that state officials now believe the Illinois Medicaid program will have between $21 and $23 billion in unpaid bills by 2017.

Purging illegal immigrants from our Illinois Medicaid rolls and implementing real reforms such as those proposed by the Illinois Policy Institute will save Illinois’ billions and insure that Illinois’ truly indigent and those with special needs are cared for. Until such reforms are implemented, Illinois Medicaid patients will continue to suffer from low reimbursement rates and long payment delays. Nursing homes and hospitals will continue to run out of money while they wait for reimbursement. And, doctors will continue to turn away poor patients and those with special needs.

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Illinois Tea Party review of Amendment to Illinois Senate Bill 2840 provides confirmation of immediate Obamacare exchange implementation.

The Illinois Tea Party has completed an initial review of the Amendment to Illinois Senate Bill 2840 issued on 5/21/2012. The following sections outline the immediate development of a state and federally subsidized “Obamacare health insurance exchange”.

Section 65 on page 68, line 18 states the following:

“Section 65. The Children’s Health Insurance Program Act is amended by changing Sections 25 and 40 as follows:

(215 ILCS 106/25)

Sec. 25. Health benefits for children.

(a) The Department shall, subject to appropriation, provide health benefits coverage to eligible children by:

(1) Subsidizing the cost of privately sponsored health insurance, including employer based health insurance, to assist families to take advantage of available privately sponsored health insurance for their eligible children; and(2) Purchasing or providing health care benefits for eligible children.”

Section 65 on page 69, line 19extends these tax subsidized health insurance exchange benefits to:

“(b) The subsidization provided pursuant to subdivision

(a)(1) shall be credited to the family of the eligible child.”

Page 73, line 4 established grants for “community based organizations to educate the public” about this new program.

Page 73, line 13 establishes a state run, web site based health insurance exchange:

“The Department shall annually publish electronically on a State website and in no less than 2 newspapers in the State the premiums or other cost sharing requirements of the Program.

Income requirements to qualify (well above the existing Federal poverty level) as well as the specific expansion of Medicaid are discussed throughout this Amendment beginning on pages 81 & 82. These income requirements and expansion clauses are very similar to the requirement outlined in the Obamacare legislation.

It is crucial to understand that what is being done here is the expansion of eligibility through increasing financial eligibility standards, or through increasing income disregards, or through the creation of new programs.

Such specific changes to our Medicaid system were prohibited by a ‘2 year moratorium” passed by the 96th General Assembly on January 25, 2011 which reads:

(215 ILCS 106/26) –

    Sec. 26. Moratorium on eligibility expansions. Beginning on the effective date of this amendatory Act of the 96th General Assembly, there shall be a 2-year moratorium on the expansion of eligibility through increasing financial eligibility standards, or through increasing income disregards, or through the creation of new programs that would add new categories of eligible individuals under the medical assistance program under the Illinois Public Aid Code in addition to those categories covered on January 1, 2011. This moratorium shall not apply to expansions required as a federal condition of State participation in the medical assistance program.
(Source: P.A. 96-1501, eff. 1-25-11.)

Illinois Senate Amendment #2 to HB5007 also includes language to implement Obamacare in Illinois 2 years early.

Amendment to Illinois Senate Bill 2840 and Amendment #2 to HB5007 provides for a federally subsidized and state subsidized health insurance exchange, as mandated in the federal Obamacare legislation (PPACA) passed on March 23, 2010. Establishing an Obamacare health insurance exchange under the guise of “Medicaid Reform” with a $700 million new price tag to the tax payers of Illinois and a projected cost of $10 billion by the year 2020 is grossly irresponsible.

Why our legislators would attempt to pass legislation now that will incur these extra costs to the Illinois tax payer when the Supreme Court of the United States will be ruling on the Constitutionality of the Obamacare legislation in 3 short weeks from today is incomprehensible and reprehensible.

Not one Republican voted for the Obamacare legislation and we expect the exact same no vote this time around from every Illinois Republican. Most especially our House Minority Leader Tom Cross.

What can you do to stop Governor Quinn, Illinois Democrats and those Republicans who support the implementation of Obamacare in our state nearly 2 years early? You can call your Illinois state representative and let them know that Illinois needs real Medicaid reform, not higher taxes and that you oppose Governor Quinn’s “Medicaid Reforms” and that you are against him establishing a state based Obamacare health insurance exchange via Executive order. Call the statehouse switchboard at (217) 782-2000 to be connected. Look up your legislator here. Again, they could vote as early as tomorrow or Tuesday.

Also call House Minority Leader Tom Cross. He seems to be ‘flip flopping’ and is ready to ‘cut a deal’. He needs to know that you value and expect principled leadership and rigorous policy reform. His statehouse number is (217) 782-1331. If the line is busy, call his district office at (815) 254-0000.

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